Kavanagh Meaghan E, Zurbau Andreea, Glenn Andrea J, Oguntala Julianah O, Josse Robert G, Malik Vasanti S, Chiavaroli Laura, Liu Simin, Kendall Cyril W C, Jenkins David J A, Sievenpiper John L
Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
BMC Med. 2025 May 21;23(1):287. doi: 10.1186/s12916-025-04067-1.
The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, has been shown to reduce cardiovascular disease (CVD) risk factors in clinical trials and lower CVD risk in observational cohorts of mainly white men and women. However, evidence on mortality outcomes in diverse populations is limited.
To examine the association of the Portfolio dietary pattern with CVD mortality in a racially diverse cohort.
A total of 14,835 US adults from the National Health and Nutrition Examination Survey, NHANES (1988-1994), were included. Diet was assessed by a 24-h dietary recall which was supplemented with a food frequency questionnaire at baseline using the Portfolio Diet Score (PDS), with positive points for nuts, plant protein, viscous fiber, phytosterols, and plant monounsaturated fatty acid sources, and negative points for foods high in saturated fat and cholesterol (range, 6-30 points). The primary outcome was CVD mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality.
During 22 years of follow-up, 2300 CVD deaths, including 1887 CHD deaths, 413 stroke deaths, and 6238 all-cause deaths were documented. Greater adherence was inversely associated with risk factors including blood lipids, glycemia, and inflammation. Treated as a continuous variable, an increase in PDS by 8 points was associated with a 12% (hazard ratio 0.88 [95% confidence intervals:0.78, 0.99]), 14% (0.86 [0.78, 0.96]), and 12% (0.88 [0.82, 0.95]) lower risk of CVD, CHD, and all-cause mortality after adjustments for known CVD risk factors. Comparing the highest to lowest tertiles of the PDS, higher PDS was associated with 16% (0.84 [0.73, 0.98]), 18% (0.82 [0.72, 0.95]) and 14% (0.86 [0.78, 0.96]) lower risk of CVD, CHD, and all-cause mortality, respectively. As part of exploratory analyses, an interaction between PDS and race/ethnicity was observed, emphasizing the necessity of future research involving underserved groups.
Among a national cohort of racially diverse adults in the US, greater adherence to the Portfolio dietary pattern was inversely and prospectively associated with CVD, CHD, and all-cause mortality.
组合饮食是一种以降低胆固醇食物为主的饮食模式，在临床试验中已被证明可降低心血管疾病（CVD）风险因素，并在主要为白人男性和女性的观察性队列中降低CVD风险。然而，关于不同人群死亡率结果的证据有限。
在一个种族多样化的队列中研究组合饮食模式与CVD死亡率之间的关联。
纳入了来自美国国家健康与营养检查调查（NHANES，1988 - 1994年）的14835名美国成年人。通过24小时饮食回顾评估饮食情况，并在基线时使用组合饮食评分（PDS）辅以食物频率问卷，坚果、植物蛋白、粘性纤维、植物甾醇和植物单不饱和脂肪酸来源记为正分，饱和脂肪和胆固醇含量高的食物记为负分（范围为6 - 30分）。主要结局是CVD死亡率。其他死亡率结局包括冠心病（CHD）、中风和全因死亡率。
在22年的随访期间，记录了2300例CVD死亡，包括1887例CHD死亡、413例中风死亡和6238例全因死亡。更高的依从性与血脂、血糖和炎症等风险因素呈负相关。作为连续变量处理时，调整已知的CVD风险因素后，PDS增加8分与CVD、CHD和全因死亡率风险分别降低12%（风险比0.88 [95%置信区间：0.78, 0.99]）、14%（0.86 [0.78, 0.96]）和12%（0.88 [0.82, 0.95]）相关。比较PDS的最高三分位数与最低三分位数，较高的PDS分别与CVD、CHD和全因死亡率风险降低16%（0.84 [0.73, 0.98]）、18%（0.82 [0.72, 0.95]）和14%（0.86 [0.78, 0.96]）相关。作为探索性分析的一部分，观察到PDS与种族/族裔之间存在相互作用，强调了未来涉及服务不足群体研究的必要性。
在美国一个种族多样化的成年人全国队列中，更高程度地坚持组合饮食模式与CVD、CHD和全因死亡率呈负相关且具有前瞻性关联。
